Supporting Premature Infant Nutrition Act of 2025
Sponsored By: Representative McGarvey
Introduced
Summary
No-cost coverage of human milk fortifier across Medicaid, CHIP, and private health plans for medically necessary use in infants under 1 year. The bill would define donor human milk-derived fortifier, set who can make medical-necessity determinations, and target a January 1, 2026 effective date.
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- Families and infants: Families with premature or medically fragile infants would get donor human milk-derived fortifier covered at no cost when a specified clinician determines it is medically necessary for an infant under 1 year.
- Medicaid and CHIP: Medicaid would add fortifier as a mandatory benefit and ban cost sharing beginning January 1, 2026. CHIP would require the same coverage and provides a transition window for states with pending legislative requirements.
- Private plans: Group and individual health plans would be required to cover fortifier without any cost sharing for plan years beginning on or after January 1, 2026.
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Bill Overview
Analyzed Economic Effects
3 provisions identified: 3 benefits, 0 costs, 0 mixed.
No-cost milk fortifier for CHIP kids
If enacted, State CHIP plans would have to cover human milk fortifier for infants under 1 when medically necessary, with no cost sharing. The rule would apply to care given on or after January 1, 2026. If a State needs new laws (not just funding) to comply, it would get until the first day of the first calendar quarter after its first regular session ends after enactment. In States with two-year sessions, each year would count as a separate session.
No-cost milk fortifier for Medicaid babies
If enacted, Medicaid would have to cover human milk fortifier for infants under 1 when medically necessary. A doctor, nurse practitioner, physician assistant, registered dietitian, or another licensed professional would make the call. Medical need could include birth at 34 weeks or earlier, birth weight under 1,800 grams, weight below healthy levels, or a condition the product helps. Plans could not charge any copays, deductibles, or similar fees for it. Coverage would start January 1, 2026.
No-cost milk fortifier in private plans
If enacted, group and individual health plans would have to cover human milk fortifier with no copays, deductibles, or coinsurance. This would apply to plan years starting on or after January 1, 2026. The bill uses the Medicaid-linked definition: a donor human milk-derived fortifier for infants under 1 when a qualified professional says it is medically necessary.
Sponsors & CoSponsors
Sponsor
McGarvey
KY • D
Cosponsors
DeLauro
CT • D
Sponsored 7/21/2025
Krishnamoorthi
IL • D
Sponsored 7/21/2025
Vargas
CA • D
Sponsored 8/29/2025
Roll Call Votes
No roll call votes available for this bill.
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